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Analyst I Claims Adjuster

3 months ago

Scarborough, Maine, United States Retail Business Services Full time
Address: USA-ME-Scarborough-145 Pleasant Hill Rd
Store Code: Claims Management

Ahold Delhaize USA, a division of global food retailer Ahold Delhaize, is part of the U.S. family of brands, which also includes five leading omnichannel grocery brands - Food Lion, Giant Food, The GIANT Company, Hannaford and Stop & Shop. Ahold Delhaize USA associates support the brands with a wide range of services, including Finance, Legal, Sustainability, Commercial, Digital and E-commerce, Technology and more.

Position Summary :

Initiates the investigation of more complex types of claims made against the company in order to determine the proximate cause and evaluate the loss exposure. Based on the investigation results, provides the appropriate response for disposition of the claim.

Duties & Responsibilities :

Claims Management
  • Performs thorough investigations, evaluations and disposition of all claims in adherence with the departmental Claims Standards and Procedures.
  • Ensures that all claims are in compliance with statutory and legal obligations.
  • Maintains quality file control by utilizing the claim diary system and reporting guidelines.
  • Provides excellent customer experiences by timely contacts and immediate follow up with concerns and/or complaints.
  • Determines proximate cause based on a detailed investigation of the loss facts. Initiates a plan for settlement or denial in accordance with jurisdictional compliance and/or state statutory requirements.
  • Maintains an accurate reserve level for the life of the claim based on the level of severity and extent of the loss exposure.
  • Recommends and presents settlement values to management above their level of authority for approval.
  • Negotiates settlements within corporate authority limit, unless otherwise authorized by management.
  • Issues timely payments to mitigate increasing costs.
Financial Impact Administration
  • Identifies all claims with subrogation potential and submit the appropriate requests for reimbursement.
  • Utilizes National Index Bureau to identify and follow up with any fraud indicators.
  • Partners with the Safety department in identifying hazards that exist in the retail and distribution operations and ways to minimize these risks.
  • Audits and approves for payment all bills for legal and vendor services.
  • Establishes personal and business goals that include interaction with legal, loss prevention and safety in order to enhance the skill set.
  • Provides coaching and mentoring to less experienced team members.
  • Enhances technical skills by attending outside training and educational opportunities.
  • Partners with Litigation Specialists to enhance skills and knowledge.
Self-Development
  • Establish personal and business goals that include interaction with legal, loss prevention and safety in order to enhance the skill set.
  • Provides coaching and mentoring to less experienced team members.
  • Enhances technical skills by attending outside training and educational opportunities.
  • Partners with Litigation Specialists to enhance skills and knowledge.
Qualifications :
  • Licensed adjuster (as appropriate by jurisdiction) or qualified to sit for licensing exam following at least I year in house training.
  • Bachelor's degree preferred, but must have minimum of 3 years claims management experience.
  • Thorough knowledge of legal procedures and processes involved in handling claims.
  • Thorough knowledge of rules, regulations, statutes and procedures pertaining to workers' compensation and general liability claims.
  • Knowledge of coaching principles and practices.
  • Knowledge of medical terminology involved in complex claims.
  • Knowledge of customer relations principles and techniques.
  • Ability to follow legal procedures and processes in the handling of complex claims.
  • Ability to mentor less experienced associates.
  • Ability to establish and maintain effective working relationships.
  • Excellent oral and written communication skills.
  • Strong negotiation skills.
#LI-BE1 #LI-Hybrid #DiceJobs #ZR

Ahold Delhaize USA, a division of global food retailer Ahold Delhaize, is part of the U.S. family of brands, which also includes five leading omnichannel grocery brands - Food Lion, Giant Food, The GIANT Company, Hannaford and Stop & Shop. When considered together, the companies of Ahold Delhaize USA comprise the largest grocery retail group on the East Coast and the fourth largest grocery retail group in the nation, serving millions of omnichannel customers each week.

Job Requisition: 373339_external_USA-ME-Scarborough_4192024